Even after years of therapy, Dr. Eugene Kester would fantasize about the sex he had had with female patients and experience what he called “euphoric recall.”

A psychiatrist, Kester knew he wasn’t cured and still needed help.

“At some point, about five years ago, that turned into remorse and going through grieving and all the harm I had done to people,” he said in November during his annual check-in with the Medical Quality Assurance Commission. “It took me that long to realize all the harm I’d done to people.”

Kester’s testimony provides a rare look into the psychology of medical caregivers who sexually abuse their patients. It also underscores the risks of treating the offenders superficially.

Of the nearly 400 practitioners the state has disciplined for sexual misdeeds in the past decade, half were allowed to return to work. Of those, nearly three out of four, 141, did so with cursory psychological treatment or none at all.

Terry Copeland, an Edmonds psychologist who treats abusers in the medical profession, says the state’s approach is “a serious mistake” because educated offenders can easily outwit it. “These guys are smart,” he said. “Anyone can get away with it for a year.”

Copeland said abusers can be rehabilitated but only if they undergo intensive therapy.

In order to break through their denials, Copeland makes them take polygraph tests, questioning them about their current conduct and motivations. Treatment often takes two to three years.

“You can call it therapy,” he said. “But really it’s accountability.”

Kester practiced in the Portland area and had licenses in both Oregon and Washington. In the 1980s and 1990s, he had sex with at least six female patients, he admitted.

He said his problems stemmed from working long hours for weeks, with almost no outside social contact, even with his wife. “I developed a compulsive way of meeting needs, which was inappropriate relationships,” Kester told the board.

Three to 10 percent of medical professionals said they had had sexual contact with a patient, according to surveys in which they were promised anonymity.

Kester fits the profile of a sex abuser in health care: white male, in his 40s or older, with a good record of public service.

Oregon revoked Kester’s license in 1996. Washington regulators gave him a second chance and approved him to work as a doctor at a state prison for men the next year.

A few years later, he took a part-time job with the Department of Social and Health Services in Spokane, where he reviews medical files. He has no contact with patients.